How Low-cost Private Health Facilities are Saving Newborns with Targeted Neonatal Emergency Obstetric Care Services in Nairobi Slums: Successes and Remaining Challenges

This blog post by Godfred Adero , a Countdown researcher, summarizes key findings from the urban health study in Nairobi, Kenya. 

Adequate neonatal Emergency Obstetric Care (EmOC) services are critical to ensure that newborn lives are saved and neonatal mortality targets are met. Countless newborn lives are still lost in African countries within the 28-day crucial period following births, and recent estimates from the United Nations show that 43 out of 48 countries in the sub-Saharan Africa region will miss their neonatal mortality target by 2030. Kenya is equally racing against time to reduce its neonatal mortality burden, which is currently estimated at 21 deaths out of 100 live births.

Neonatal emergency services are designed to address the urgent medical needs of newborns, particularly those who are premature, have low birth weight, or are suffering from serious health conditions such as respiratory distress, infections, or congenital abnormalities. These services include immediate resuscitation, stabilization, and intensive care, often requiring specialized equipment and trained healthcare workers to provide life-saving assistance. Access to timely and effective neonatal emergency care significantly reduces neonatal deaths and improves long-term health outcomes, helping to ensure that newborns not only survive but also fully develop.

In Nairobi slums, where health risks are characterized by factors such as poor sanitation, malnutrition, and lack of maternal healthcare, the availability and adequacy of neonatal emergency services are vital for improving infant survival rates and supporting overall well- being.

Countdown conducted a study to assess the quality of maternal and newborn health care provided in informal settlements in Viwandani and Korogocho. The study focused on evaluating the readiness of health facilities, understanding women’s experiences with patient-centered maternity care, and assessing providers’ perceptions of delivering these services. The study used a cross-sectional design, including health facility assessments, exit surveys with 412 women, in- depth interviews with 24 healthcare providers, and 3 key informant interviews with county health officials.

Stories of Successes
Our study shows great improvements in multiple areas of health facility preparedness amidst systemic issues such as poor infrastructure, scarcity of specialized facilities and trained personnel, limited access to essential medicines, and financial barriers.

All seven facilities we surveyed consistently supplied injectable antibiotics for neonatal infections, including ceftriaxone and amoxicillin. This is a positive indicator of the facilities’ capacity to manage infections, a common and severe threat to newborn health. However, the limited availability of essential medicines like beta or dexamethasone (43%) highlights critical areas for improvement. These medications are vital for managing various neonatal conditions and ensuring comprehensive care.

All seven facilities had guidelines, protocols, and job aids for Kangaroo Mother Care (KMC) staff who received KMC training within the last two years. KMC is essential for improving the survival of preterm and low-birth-weight infants by promoting skin-skin contact, which stabilizes temperature, heart rate, and breathing. These items can help providers implement KMC effectively, reducing infections, improving breastfeeding, and enhancing newborn health. By providing these practices, KMC can significantly reduce infant mortality and improve the survival chances of vulnerable newborns in informal settlements.

Four of the seven facilities have necessities like medication delivery mechanisms for infusion and IV fluids, resuscitation tables with heat sources, and infant weighing scales with 100g gradation.

Where More Action is Needed to Save Lives
While there are commendable aspects in the readiness of health facilities in Viwandani and Korogocho to provide care for Small and Sick Newborns (SSNs), such as the availability of essential medicines and recent training in KMC, prioritizing overall preparedness remains critical.

The overall care for SSNs remains insufficient, as indicated by a score of 42.9%. A significant gap is the lack of guidelines for managing neonatal sepsis, a life-threatening condition that requires prompt and effective intervention. Additionally, training in critical areas, such as management of neonatal sepsis and resuscitation, oxygen and therapy support, and monitoring use of neonatal equipment, has only been provided to a few staff members. Without adequate training and clear guidelines for managing neonatal sepsis, there is a risk of suboptimal outcomes for affected newborns, highlighting the urgent need to enhance training and develop comprehensive protocols to improve neonatal care. Essential equipment such as caps/hats, infant incubators, and registers to record KMC services and the lack of beds for caregivers to stay overnight still affect the quality of care being provided to SSNs, affecting their survival and recovery.

Some of the Needed Actions Include:
1. Continuous assessments of gaps in specific medications and comprehensive training. The monitoring teams can do this through routine facility-led audits using digital tools like mobile-based applications to track medication stocks and staff training needs.
2. Expanding training programs to provide comprehensive education for all staff in managing neonatal sepsis and other critical neonatal care protocols is also essential. Moreover, creating detailed guidelines for managing various neonatal conditions will ensure that all facilities have the necessary resources and knowledge to provide optimal care.
3. Key actions can be taken by stakeholders to enhance facility readiness for SSN care. Government and health authorities should allocate resources for essential medicine equipment and develop policies on neonatal sepsis management. Facilities management must prioritize staff training and implement a monitoring system for continuous assessment.

In conclusion, enhancing the readiness of health facilities in urban informal settlements to care for SSNs requires coordinated action from all stakeholders. By addressing these gaps in resources, training, and equipment and establishing clear protocols, these facilities can significantly improve outcomes for newborns in informal settings. Continuous assessment supported by innovative tools and external support will also ensure that the system remains
responsive to the needs of newborn care.